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Stress Incontinence in Women: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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Get the facts

Your options

Key points to remember

Surgery is usually done only after other treatments for stress incontinence have failed.

You may be able to treat stress incontinence by doing pelvic floor exercises (Kegels). They may help you control your bladder when you cough, laugh, sneeze, or exercise.

Medicines may help you control urine leaks, but they don't work for everyone. Other methods to help prevent leaks include using a medical device, such as a pessary.

Incontinence can have more than one cause. Surgery can fix stress urinary incontinence. But if you have mixed urinary incontinence, you may still have urgency symptoms after surgery.

Surgery works better than any other treatment for stress urinary incontinence in women.footnote 1 But sometimes surgery for stress incontinence causes new symptoms of urgency or urge incontinence. And sometimes symptoms come back.

Surgery has risks, including trouble urinating after surgery, injury to the bladder or other pelvic organs, problems caused by the mesh tape used in surgery, infection, and problems linked to anesthesia.

Stress incontinence is the accidental release of urine that occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It's the most common type of incontinence in women.

Stress incontinence can be caused by childbirth, weight gain, or other problems that stretch the pelvic floor muscles. When these muscles can't support your bladder, the bladder drops down and pushes against the vagina. You're not able to tighten the muscles that close off the urethra. Urine may leak because of the extra pressure on your bladder.

Incontinence can have more than one cause, so your doctor will treat the main cause first. Surgery for stress incontinence is usually done only after other treatments have failed.

Other treatments you might try include:

Kegel exercises. These are also called pelvic floor exercises. They strengthen the pelvic muscles that control urination. You can do these exercises at any time without anyone knowing you're doing them. Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had fewer leakage problems a day and said their quality of life was better.footnote 2

Medicines. These can be used to reduce how often you leak and can improve your quality of life. But medicines rarely cure stress incontinence.footnote 3

Medical devices. These are products used to prevent urine from leaking, such as a pessary. A pessary is a device that fits into the vagina to support the bladder. Another option is a nonprescription product which you insert like a tampon, such as Poise Impressa. It lifts and supports the urethra to help prevent urine from leaking.

Electrical stimulation, which sends a mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination. Electrical stimulation of the pelvic floor muscles may reduce how often you leak.footnote 4

Surgery may be done when stress incontinence is severe and other treatments have not worked. Surgery lifts and supports the connection between the bladder and the urethra.

Surgery works better than any other treatment for stress urinary incontinence in women.footnote 1 But sometimes symptoms come back.

Types of surgery include:

Tension-free vaginal tape (TVT). In this surgery, a mesh tape is placed under the urethra like a sling to support it and return it to its natural position. Surgery takes about 30 minutes and is usually done under local anesthesia. Another procedure called transobturator tape (TOT) surgery is like TVT. Both TVT and TOT cure stress incontinence in about 8 out of 10 women. That means that about 2 out of 10 women still have problems with incontinence after this kind of surgery.footnote 5

Retropubic suspension. This surgery lifts the sagging bladder neck and urethra by attaching support tissue to the pubic bone or tough ligaments. It requires general anesthesia and 2 or 3 days in the hospital. Depending on how it is done, surgery cures stress incontinence in about 8 or 9 out of 10 women in the first year. Five years after surgery, about 7 out of 10 women are still "dry."footnote 6

Sling surgery. This surgery involves making deep cuts in the belly to get to the bladder and urethra. The surgeon uses a piece of muscle, ligament, or tendon tissue or synthetic material to make a sling. The sling lifts the urethra back into a normal position. It requires general anesthesia and 2 or 3 days in the hospital. Sling surgery is usually done after other surgeries have failed. It works well to get rid of stress incontinence.footnote 1

Talk with your doctor about things you can do to increase the chance of having a successful surgery. You may have better results if you lose weight or do Kegels before surgery. If you smoke, quit.

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I started having stress incontinence after my son was born. After I had my second child, it got worse. I feel like I am way too young to be wearing pads or diapers, and I worry that other people will notice the smell. My doctor showed me how to do some exercises to strengthen the muscles that help hold urine in. I know other women who have been helped by them. I am glad to have options other than surgery.

Tina, age 39

I thought I had tried everything for my stress incontinence. I can manage it most of the time, but when I jog, I get quite a bit of dribbling. I went to my doctor to find out whether there was anything I hadn't tried or whether surgery was my only other option. We talked about a lot of options, like pelvic floor exercises and wearing a tampon when I jog to put a little pressure on my urethra and stop the leaking. I am going to give those methods a try.

Maria, age 45

Ever since I was in my 20s, I have leaked a little bit of urine when I cough or sneeze or exercise. After I had my kids, it seemed to get worse. I really wanted a solution that would take care of the problem all the time. Even though there are some risks, my doctor and I agreed that surgery was a reasonable choice for me.

Faith, age 39

At my last visit, my doctor and I talked about many aspects of getting older: the leaking urine, the weaker bones, the change in my hormones, and all that. I was surprised to learn about surgery to help with my urine leakage problem. It is good to know that so many women have had success from surgery.

Carrie, age 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

I've tried Kegel exercises, but they haven't worked for me.

I think that Kegels might work for me.

More important

Equally important

More important

I don't want to wear absorbent pads or try a pessary to avoid leakage.

I don't mind wearing pads or trying a pessary.

More important

Equally important

More important

I've tried medicines, but they don't work for me.

I think that medicines might work for me.

More important

Equally important

More important

Stress incontinence lowers my quality of life.

My quality of life is not too bad.

More important

Equally important

More important

I think surgery can help me.

I don't want to have surgery for any reason.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, Is surgery usually the first treatment for stress incontinence?

YesSorry, that's not right. Surgery is usually done only after other treatments have failed.

NoYou're right. Surgery is usually done only after other treatments have failed.

I'm not sureIt may help to go back and read "Get the Facts." Surgery is usually done only after other treatments have failed.

2.2, Can pelvic floor exercises help with stress incontinence?

YesYou're right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.

NoSorry, that's not right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.

I'm not sureIt may help to go back and read "Get the Facts." Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.

3.3, Can symptoms come back after surgery?

YesYou're right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.

NoSorry, that's not right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.

I'm not sureIt may help to go back and read "Get the Facts." Surgery can often cure incontinence. But sometimes symptoms come back.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Stress Incontinence in Women: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

1. Get the Facts

Your options

Key points to remember

Surgery is usually done only after other treatments for stress incontinence have failed.

You may be able to treat stress incontinence by doing pelvic floor exercises (Kegels). They may help you control your bladder when you cough, laugh, sneeze, or exercise.

Medicines may help you control urine leaks, but they don't work for everyone. Other methods to help prevent leaks include using a medical device, such as a pessary.

Incontinence can have more than one cause. Surgery can fix stress urinary incontinence. But if you have mixed urinary incontinence, you may still have urgency symptoms after surgery.

Surgery works better than any other treatment for stress urinary incontinence in women.1 But sometimes surgery for stress incontinence causes new symptoms of urgency or urge incontinence. And sometimes symptoms come back.

Surgery has risks, including trouble urinating after surgery, injury to the bladder or other pelvic organs, problems caused by the mesh tape used in surgery, infection, and problems linked to anesthesia.

FAQs

What is stress incontinence?

Stress incontinence is the accidental release of urine that occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It's the most common type of incontinence in women.

Stress incontinence can be caused by childbirth, weight gain, or other problems that stretch the pelvic floor muscles. When these muscles can't support your bladder, the bladder drops down and pushes against the vagina. You're not able to tighten the muscles that close off the urethra. Urine may leak because of the extra pressure on your bladder.

How is it treated?

Incontinence can have more than one cause, so your doctor will treat the main cause first. Surgery for stress incontinence is usually done only after other treatments have failed.

Other treatments you might try include:

Kegel exercises. These are also called pelvic floor exercises. They strengthen the pelvic muscles that control urination. You can do these exercises at any time without anyone knowing you're doing them. Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had fewer leakage problems a day and said their quality of life was better.2

Medicines. These can be used to reduce how often you leak and can improve your quality of life. But medicines rarely cure stress incontinence.3

Medical devices. These are products used to prevent urine from leaking, such as a pessary. A pessary is a device that fits into the vagina to support the bladder. Another option is a nonprescription product which you insert like a tampon, such as Poise Impressa. It lifts and supports the urethra to help prevent urine from leaking.

Electrical stimulation, which sends a mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination. Electrical stimulation of the pelvic floor muscles may reduce how often you leak.4

When is surgery done for stress incontinence?

Surgery may be done when stress incontinence is severe and other treatments have not worked. Surgery lifts and supports the connection between the bladder and the urethra.

Surgery works better than any other treatment for stress urinary incontinence in women.1 But sometimes symptoms come back.

Types of surgery include:

Tension-free vaginal tape (TVT). In this surgery, a mesh tape is placed under the urethra like a sling to support it and return it to its natural position. Surgery takes about 30 minutes and is usually done under local anesthesia. Another procedure called transobturator tape (TOT) surgery is like TVT. Both TVT and TOT cure stress incontinence in about 8 out of 10 women. That means that about 2 out of 10 women still have problems with incontinence after this kind of surgery.5

Retropubic suspension. This surgery lifts the sagging bladder neck and urethra by attaching support tissue to the pubic bone or tough ligaments. It requires general anesthesia and 2 or 3 days in the hospital. Depending on how it is done, surgery cures stress incontinence in about 8 or 9 out of 10 women in the first year. Five years after surgery, about 7 out of 10 women are still "dry."6

Sling surgery. This surgery involves making deep cuts in the belly to get to the bladder and urethra. The surgeon uses a piece of muscle, ligament, or tendon tissue or synthetic material to make a sling. The sling lifts the urethra back into a normal position. It requires general anesthesia and 2 or 3 days in the hospital. Sling surgery is usually done after other surgeries have failed. It works well to get rid of stress incontinence.1

Talk with your doctor about things you can do to increase the chance of having a successful surgery. You may have better results if you lose weight or do Kegels before surgery. If you smoke, quit.

Why might your doctor recommend surgery for stress incontinence?

Your doctor may suggest surgery if:

You have tried other treatments, and they have not helped.

You and your doctor know the cause of your stress incontinence. Surgery is more likely to fail if the true cause isn't known.

Personal stories

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I started having stress incontinence after my son was born. After I had my second child, it got worse. I feel like I am way too young to be wearing pads or diapers, and I worry that other people will notice the smell. My doctor showed me how to do some exercises to strengthen the muscles that help hold urine in. I know other women who have been helped by them. I am glad to have options other than surgery."

— Tina, age 39

"I thought I had tried everything for my stress incontinence. I can manage it most of the time, but when I jog, I get quite a bit of dribbling. I went to my doctor to find out whether there was anything I hadn't tried or whether surgery was my only other option. We talked about a lot of options, like pelvic floor exercises and wearing a tampon when I jog to put a little pressure on my urethra and stop the leaking. I am going to give those methods a try."

— Maria, age 45

"Ever since I was in my 20s, I have leaked a little bit of urine when I cough or sneeze or exercise. After I had my kids, it seemed to get worse. I really wanted a solution that would take care of the problem all the time. Even though there are some risks, my doctor and I agreed that surgery was a reasonable choice for me."

— Faith, age 39

"At my last visit, my doctor and I talked about many aspects of getting older: the leaking urine, the weaker bones, the change in my hormones, and all that. I was surprised to learn about surgery to help with my urine leakage problem. It is good to know that so many women have had success from surgery."

— Carrie, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

I've tried Kegel exercises, but they haven't worked for me.

I think that Kegels might work for me.

More important

Equally important

More important

I don't want to wear absorbent pads or try a pessary to avoid leakage.

I don't mind wearing pads or trying a pessary.

More important

Equally important

More important

I've tried medicines, but they don't work for me.

I think that medicines might work for me.

More important

Equally important

More important

Stress incontinence lowers my quality of life.

My quality of life is not too bad.

More important

Equally important

More important

I think surgery can help me.

I don't want to have surgery for any reason.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Is surgery usually the first treatment for stress incontinence?

Yes

No

I'm not sure

You're right. Surgery is usually done only after other treatments have failed.

2.
Can pelvic floor exercises help with stress incontinence?

Yes

No

I'm not sure

You're right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.

3.
Can symptoms come back after surgery?

Yes

No

I'm not sure

You're right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

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